S.K. Boyenko, V.V. Tolchinsky, N.G. Mironenko Donetsk State Medical Institute named after M. Gorky (Rector - Academician V.N. Kazakov), Department of the Faculty of Postgraduate Education (Head of Department - Prof. S.K. Boyenko) Institute of Emergency and Reconstructive Surgery of the Academy of Medical Sciences of Ukraine named after prof. V.K. Gusak (Director - Prof. V.K. Grin), Department of Plastic and Reconstructive Surgery of the Head and Neck (Head of Department - PhD V.V. Tolchinsky) Restoration of voice function is an important aspect of rehabilitation of patients with laryngeal cancer stages III, IV after total larynx removal. We have been dealing with this problem at the ENT Clinic of the Institute of Emergency and Reconstructive Surgery in Donetsk for about 30 years. The aim of our work was to improve the quality of life by restoring the voice function lost after laryngectomy through the implementation of immediate and delayed reconstructive interventions in patients with stage III-IV malignant neoplasms of the larynx. Materials and methods. During the period 2000-2005, we performed laryngectomy with one of the types of voice restoration surgery in 197 patients with stage III-IV laryngeal cancer: immediate tracheopharyngeal or tracheoesophageal mucosal shunting in 114 (57.87%), delayed tracheoesophageal shunting in 52 (26.39%), and tracheoesophageal shunting with prosthetics in 31 (15.74%). The patients underwent surgery in men aged 42 to 69 years, patients with laryngeal cancer, with a histologically verified diagnosis. Of these, 108 patients had stage T3N0M0 lesions, 51 had stage T4N0M0, and 38 had stage T4N1M0 lesions. In addition to laryngectomy, the following were performed in 38 patients with stage T4N1M0 disease: Krail's procedure (24) and fascio-caseous excision of the lateral neck tissue (14). All patients underwent one of the voice restoration surgery types. The choice of voice restoration surgery type depended on the tumor process location in the larynx and the extent of its spread to the laryngopharynx, cricoid space, and trachea. Surgical interventions along the metastatic pathways were not contraindications to voice restoration surgery. When the tumor process was limited to two floors of the larynx, without spreading to the subglottic region, an original technique with mobilization of the last of the preserved tracheal semirings was used. In these cases, a voice shunt was created on the anterior wall of the hypopharynx. With this method, the shunt is closed during swallowing and opens during phonation under the influence of the exhaled air stream. If the tumor has spread to the subglottic region up to the first tracheal hemiring, into the retrocricoid space, or to the laryngopharynx, adherence to the principles of ablastic surgery does not allow for the preservation of significant sections of the hypopharynx and the upper trachea, which are necessary for the formation of a tracheopharyngeal shunt. In such cases, we performed an extended laryngectomy with a simultaneous voice restoration surgery using an original technique developed in the clinic: tracheoesophageal mucosal shunting (Ukrainian patent for patent application No. 2003032547 dated November 11, 2003, Bulletin No. 11). The essence of this surgery is the creation of a stable tracheoesophageal junction, the walls of which are lined with the epithelial layer of the esophageal mucosa, and the dividing function is ensured by maximal preservation of the muscular layer of the esophageal wall. In cases of unsatisfactory results of tracheoesophageal bypass (aspiration of saliva and food, poor voice function), a voice prosthesis was installed in the junction formed between the trachea and esophagus. Installation of a voice prosthesis in such cases is technically simple and well-tolerated by patients. The reconstructed voice was evaluated using computer acoustic analysis using licensed software. Results and discussion are presented. In cases of simultaneous tracheopharyngeal shunting with laryngectomy and mobilization of the last of the preserved tracheal half-rings, voice function was restored in 81 (71.05%) cases, in cases of simultaneous tracheoesophageal shunting – in 24 (46.15%) cases, and in cases of delayed and simultaneous tracheoesophageal mucosal shunting with installation of a voice prosthesis – in 29 (93.24%) cases. One of the main criteria for assessing voice quality in computer acoustic analysis is the fundamental frequency (FPF) – the average vibration velocity of the voice source, measured in Hz per second. The HR for simultaneous tracheopharyngeal mucosal shunting (TMS) and laryngectomy is 109-112 Hz, for simultaneous tracheoesophageal shunting (TMS) it is 107-109 Hz, and for tracheoesophageal mucosal shunting with prosthetic replacement it is 111-112 Hz. These results do not differ significantly between the different types of these procedures. Conclusions. Good functional results can be achieved using various types of shunting surgeries, with the qualitative characteristics of the reconstructed speech being quite high. The combination of tracheoesophageal shunting and voice prosthetics expands the possibilities for rehabilitation of patients after laryngectomy.